Abstract
Objective
To compare “sandwich chemo-radiotherapy” with six cycles of chemotherapy followed by adjuvant radiotherapy with respect to tolerability and acute toxicity.
Materials and methods
Twenty-five women with surgically staged IIIC endometrial cancer were included. Treatment consisted of either three cycles of paclitaxel (175 mg/m²) and carboplatin (AUC 6) on a q21-day schedule followed by irradiation (45–50.4 Gy) or six cycles of the same chemotherapy followed by radiotherapy. Acute toxicity related to either chemotherapy or radiotherapy was evaluated.
Results
Median age was 61.5 years (range 36–83 years). Eleven patients had sandwich chemo-radiotherapy, and the other 14 patients had 6 cycles of chemotherapy followed by radiotherapy. Three out of the five patients who could not complete all the cycles in the sandwich chemo-radiotherapy group had pelvic and para-aortic radiotherapy. Acute radiotherapy related grade 1–2 gastrointestinal system (GIS) and genitourinary system (GUS) toxicities were observed in 72.8 and 63.6 % of patients, respectively, for sandwich group. Undesired treatment breaks in the course of radiotherapy were observed in six patients for sandwich chemo-radiotherapy and in one patient receiving six cycles of chemotherapy followed by radiotherapy. All the patients who had undesired treatment breaks in the sandwich chemo-radiotherapy group had pelvic and para-aortic radiotherapy.
Conclusion
Sandwich chemo-radiotherapy seems to be more toxic particularly for patients who had pelvic and para-aortic irradiation. Therefore, it might be more convenient to delay radiotherapy after six cycles of chemotherapy for patients with the indication of pelvic para-aortic radiotherapy.
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References
Scribner DR Jr, Puls LE, Gold MA (2012) A phase II evaluation of docetaxel and carboplatin followed by tumor volume directed pelvic plus or minus para aortic irradiation for stage III endometrial cancer. Gynecol Oncol (Epub ahead of print)
Ayhan A, Taskiran C, Celik C, Aksu T, Yuce K (2002) Surgical stage III endometrial cancer: analysis of treatment outcomes, prognostic factors and failure patterns. Eur J Gynaecol Oncol 23:553–556
Randall ME, Filiaci VL, Muss H et al (2006) Randomized phase III trial of whole abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a gynecologic oncology group study. J Clin Oncol 24:36–44
Randall ME, Filiaci VL, Muss H et al (2006) Randomized phase III trial of whole abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a gynecologic oncology group study. J Clin Oncol 24:36–44
Mundt AJ, McBride R, Rotmensch J et al (2001) Significant pelvic recurrence in high-risk pathologic stage I-IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys 50:1145–1153
Keys HM, Roberts JA, Brunetto VL et al (2004) A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a gynecologic oncology group study. Gynecol Oncol 92:744–751
Creutzberg CL, van Putten WL, Warlam-Rodenhuis CC et al (2004) Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the postoperative radiation therapy in endometrial carcinoma trial. J Clin Oncol 22:1234–1241
Alvarez Secord A, Havrilesky LJ, Bae-Jump V et al (2007) The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer. Gynecol Oncol 107:285–291
Duska LR, Berkowitz R, Matulonis U et al (2005) A pilot trial of TAC (paclitaxel, doxorubicin, and carboplatin) chemotherapy with filgrastrim (r-metHuG-CSF) support followed by radiotherapy in patients with “high-risk” endometrial cancer. Gynecol Oncol 96:198–203
Gabriele A, Lissoni A, Cormio G et al (1998) Cisplatin, doxorubicin and cyclophosphamide (PAC) followed by radiation therapy in high-risk endometrial carcinoma. Int J Gynecol Cancer 8:397–402
Bruzzone M, Miglietta L, Franzone P et al (2004) Combined treatment with chemotherapy and radiotherapy in high-risk FIGO stage III–IV endometrial cancer patients. Gynecol Oncol 93:345–352
Lupe K, Kwon J, D’Souza D et al (2007) Adjuvant paclitaxel and carboplatin chemotherapy with involved field radiation in advanced endometrial cancer: a sequential approach. Int J Radiat Oncol Biol Phys 67:110–116
Faught W, Fung MFK, Krepart GV, Lotocki RJ, Heywood MS, Genest P (1998) Microscopic surgical stage IIIc endometrioid adenocarcinoma of the endometrium: implications for bimodal adjuvant therapy. Int J Gynecol Cancer 8:41–45
Shah PH, Kudrimoti M, Feddock J, Randall M (2011) Adjuvant treatment for stage IIIC endometrial cancer: options and controversies. Gynecol Oncol 122:675–683
Geller MA, Ivy J, Dusenbery KE, Ghebre R, Isaksson Vogel R, Argenta PA (2010) A single institution experience using sequential multi-modality adjuvant chemotherapy and radiation in the “sandwich” method for high risk endometrial carcinoma. Gynecol Oncol 118:19–23
Alvarez Secord A, Havrilesky LJ, Bae-Jump V, Chin J, Calingaert B, Bland A et al (2007) The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer. Gynecol Oncol 107:285–291
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Dogan, N.U., Yavas, G., Yavas, C. et al. Comparison of “sandwich chemo-radiotherapy” and six cycles of chemotherapy followed by adjuvant radiotherapy in patients with stage IIIC endometrial cancer: a single center experience. Arch Gynecol Obstet 288, 845–850 (2013). https://doi.org/10.1007/s00404-013-2817-9
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DOI: https://doi.org/10.1007/s00404-013-2817-9